| NPI | 1801879028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME140171) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35070198) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2023-03-07 |